Noninvasive electrical stimulation of the spinal cord as a method of correcting walking after a stroke

The effect of noninvasive trasnscutaneous spinal cord stimulation (scTS) on walking parameters in patients after a cerebral infarction or ischemic stroke was investigated. It has been shown that after the use of scTS while walking on the floor the speed of movement, the length of the step cycle, the height of the foot elevation and the amplitude of movements in the hip, knee and ankle joints increased, which shows the ability of using scT to correct walking after a stroke. Key words: spinal cord, electrical stimulation, stroke, walking.

Spinal Cord Stimulator for Treating Chemotherapy-induced Peripheral Neuropathy

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is not only one of the most common adverse experiences of cancer survivors, but it is also one which has the greatest effect on quality of life. Ultimately, CIPN can lead to unwanted modification of treatment such as chemotherapy dose reductions or termination of treatment altogether. CASE REPORT: We present a case of a 47-year-old man with severe bilateral CIPN resistant to conservative management, who was successfully treated with spinal cord stimulation. CONCLUSION: Spinal cord stimulation can be an effective treatment for CIPN resistant to conservative management. KEY WORDS: Spinal cord stimulator, chemotherapy induced neuropathy, peripheral neuropathy

Hypodermis Tension Loop: A New Preventative Measure for Lead Migration in the Morbidly Obese

Electrode migration/displacement is reported to be the most common complication of spinal cord stimulator (SCS) implantation, with the literature reporting incidences from 13.2% to 22.6%. There have been numerous publications describing techniques preventing lead migration, with most involving tying leads to skin and fascia for trial and permanent leads, respectively. However, few have addressed how to prevent migration in the case of hypermobile tissue seen in the morbidly obese. We describe the creation of subcutaneous tension loops to prevent lead migration. Key words: Spinal cord stimulator, trial, lead migration, subcutaneous tissue, hypodermis, tension loop, morbidly obese

Late Extrusion of an Implantable Pulse Generator of a Spinal Cord Stimulator

The objective of this manuscript was to report a case of a patient with extruded pulse generator 3 years after implantation of a spinal cord stimulator system. With the increasing incidence of chronic pain, spinal cord stimulation (SCS) is becoming more commonly utilized by pain physicians. SCS is a generally safe intervention with minimal adverse effects; however, there are risks of complications which practitioners should be aware of prior to and after placement of the SCS. We present a case of a patient with a late complication of extrusion of an implantable pulse generator (IPG) of a SCS that was promptly identified and successfully removed without any complications. A 60-year-old male truck driver with history of failed back syndrome and diabetes underwent a SCS system implanted with excellent relief of his pain. The SCS was implanted with 2 leads with the IPG being sutured 3 cm in depth in the superior gluteal region. Three years after the implantation, he developed pain over the site of the generator and presented to our clinic with extrusion of the non-rechargeable pulse generator from his gluteal region. The pulse generator was successfully removed with the battery not being infected. This late complication may have been related to his ongoing profession of daily driving with pressure necrosis from prolonged sitting and constant vibration during long rides associated. Structural size and design of the pulse generator may have had an important contribution as well. To our knowledge this complication has not been reported in the literature. Physicians that place or manage patients with SCSs should be aware of this rare complication and maintain vigilance even after remote implantation of the SCS systems. Key words: Spinal cord stimulator, complication, extrusion, implantable pulse generator, neuromodulation, failed back syndrome, battery complication

Neuromodulation in the Management of Pain from Brachial Plexus Injury

We are presenting a paper on the effectiveness of spinal cord stimulation (SCS) in 2 patients suffering pain from brachial plexus injury (BPI). After a traumatic brachial plexus lesion about 80% of patients develop pain in the deafferentated arm. This pain is considered very resistant to many forms of therapy. In the early 1970s, SCS was introduced in the treatment of BPI pain with disappointing results. There are only about 20 published cases of BPI pain treated with SCS. Many injuries are due to motorcycle accidents, so that patients are often young and require long-term pain relief. During the SCS trial the pain relief was more than 50% with an absolute improvement in the quality of life and significant drug reduction. The results of the SCS were excellent in these 2 patients, defined as more than 50% pain relief at 6 and 18 months. Key words: Spinal cord stimulation, brachial plexus injury, neurophatic pain.